19103 - Laserfiche WebLink

Home Browse Search

17 OFFICE USE: 1 _ v_:._3_ -------------,c,�,_,3 APPLICATION FOR SANITATION PERMIT Permit No. �r J_..__ __________________- (Complete in Duplicate) �;�--- -- - � { P Date Issued ..-•--- --'� ..:...............__-- _- --__ _��------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-_- p ®------ rJl-1Q ____Wa _________- ----------------------------------------------------------------------- Owner's .Name---� -p-4.1_ --•------v�• a------ -f'.----rT h�--- ------------ -------- Phone Address-- M.._Z---------- ----------------------------- •-•-- Contractor's Name----�-1C-e',S------- Sr-------- ------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of lMnq units: Number of bedrooms J---- Number of baths -1----- Lot size ____Q d .__ `_____________________________ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table 1_0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe r ardpan ❑ , Previous Application Made: (If yes,date--------------------) No P�'_ New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well_________________Distance from foundation--------------------Material__..---_..___._.__._________.____._--_._._____- No. of compartments--------------------------Size------••------------------------Liquid depth---- ---------------------Capacity.--------- •----------- Disposal ield: Distance from nearest well.-ZAP..__.Distance from foundation__La----------- Distance to nearest lot line---_—S d._--_. Number of lines-------1----------------------Length of each line__�P-------- -`.....Width of trench.-at:*{ ¢_------------------- Type of filter material_"7Q_"T-__...__Depth of filter materiaL4i3*_______._Total length-----4C0---._____._-_--______________r Seepage Pit: Distance to nearest well../OD------------Distance from foundation__/A_`_____--Distance to nearest lot line_-s ❑/ Number of pits....,Z--------------Lining material_-�(aCr/----.Size: Diameter.__-_jt-_8-----------Depth......as7-__--------------G Cesspool: Distance nearest wel€------=------ - Distance from foundation--------------`-- ❑ SizeDiameter ----------------- - DepLiquid Capacity_ --------------------------gals•z� Privy: Distance from nearest well_______________ - ...___...._Distance from nearest buildingr ❑ Distance to nearest lot line,--.- -------------------------------- -------- I-------------------------------------------------------------------------------- 0,7 . :. g Ides_c.r #- _Le- ---- - - -------- Remodeling and/or re aii ibe :-- ......7_111- - «. 6 ------------ -- = --------- --------------------------------------------------•------------------------------------------------- ----------------------------•------------------------------------------------- ------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- `------------------ ----- ---- -------=---------------- --- ------------------ ------------------------------------ {Owner and/or Contractor]f Title (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 4 j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... ------------------------------- DATE--- --------------------- REVIEWEDBY--------------------------------------------- ------------------------ ------------------------------------------------------- DATE------------------------------------------------------------ I BUILDING PERMIT ISSUED------------------ ---- t-------------------- DATE---------------------------- ------------ Alterations and/or recommendations:-__.____ ____�. _ _Kn -- L ----------- - 7 � = r - ----- 5 �i/. - - I------------------------------------ ------------------------------------------------------------------------ ----------------------------------------------------- ---------------------------------------------------------------------------- --------------------------- --------------------------- ----------- --- -------------------------------•----------- --------------------------- � � --------- Date------- ------------ r~ : FINAL INSPECTION BY:----` i— -------- ------ -------------- -- - ------ ---------------- ! S JOAQUIN LOCAL HEALTH DISTRICT F 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California L